Type 2 diabetes mellitus in adults - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Type 2 diabetes therapy for all patients hinges around a personalized self-management program, usually developed with the patient by a diabetes education nurse or nutritionist.
Lifestyle changes plus metformin are initial antihyperglycemic therapy for most patients, although for individuals with atherosclerotic cardiovascular disease (ASCVD) or at high risk of ASCVD, heart failure, or chronic kidney disease, sodium-glucose cotransporter-2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists should be prioritized for their cardiorenal protective effects. Glycemic goals and treatment choices should be individualized. Due to the progressive nature of the condition, it often requires escalation/combination therapy.
For patients with overweight or obesity, weight management should be considered as a therapeutic target in addition to glycemia, and drugs chosen that both promote weight loss and lower glucose. This particularly includes GLP-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists.
Management of blood pressure and lipids, smoking cessation, and antiplatelet therapy (where indicated) are essential to reduce the risk of the macrovascular and microvascular complications associated with type 2 diabetes.

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History & Exam
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Definition

Epidemiology

Etiology

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Acanthosis nigricans involving the axilla

Citations

Key Articles

American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan 1;47(suppl 1):S1-321.[Full Text]
Cappola AR, Auchus RJ, El-Hajj Fuleihan G, et al. Hormones and aging: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2023 Jul 14;108(8):1835-74.[Abstract][Full Text]
US Preventive Services Task Force. Prediabetes and type 2 diabetes: screening. Aug 2021 [internet publication].[Full Text]
Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the study of diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-86.[Abstract][Full Text]
Qaseem A, Obley AJ, Shamliyan T, et al. Newer pharmacologic treatments in adults with type 2 diabetes: a clinical guideline from the American College of Physicians. Ann Intern Med. 2024 May;177(5):658-66.[Abstract][Full Text]

Other Online Resources

CDC: Prediabetes Risk Test
American Diabetes Association: components of the comprehensive diabetes medical evaluation at initial, follow-up, and annual visits
Dietary Guidelines for Americans
FDA: new warning and contraindication for blood pressure medicines containing aliskiren (Tekturna)
BMJ: PCSK9 inhibitors and ezetimibe for the reduction of cardiovascular events: a clinical practice guideline with risk-stratified recommendations

Referenced Articles

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